by Margaret O’Hara and Nicholas Gilmore, Searchlight New Mexico
The bodies were found behind locked doors or tucked away in secluded alleys. They were found in bedrooms, bathrooms, parking lots and behind the wheels of parked cars.
One man was found face-down behind an organic grocery story. A woman was in a tent next to the Santa Fe River. The manager of an office supply store was slumped over a bathroom stall.
Santa Fe County saw 104 opioid deaths in 2025 — two deaths a week on average. New Mexico as a whole had 900 deaths, a 21% increase from the year before, New Mexico Department of Health data shows, even as overdose fatalities nationwide have been on a decline.
New Mexico now ranks fourth among states in the overdose death rate.
One drug — fast-acting, addictive fentanyl — has accounted for nearly 70% of the state’s overdose deaths in the last decade, federal data shows.
The trend has taken a particular toll in Northern New Mexico, where Rio Arriba, Santa Fe and Taos counties each saw a staggering increase of more than 65% in opioid deaths. Rio Arriba County, with its generational struggle with opioid addiction, for decades has ranked near the top in the nation for fatal overdoses. It had a death rate nearly five times the national average in 2024 and more than three times the state average.
The harm extends beyond the user’s death. Opioid misuse leads to high rates of newborn drug exposure and even child overdose deaths, burying prosecutors’ offices in criminal cases and exacerbating the sharp rise of homelessness.
Advocates point to the complexity of addressing the intertwining troubles of homelessness, substance use disorder and mental illness.
“Substance use disorders, they leave this wake of wreckage through families and communities; it’s not just the patient that we see that suffers,” said Dr. Eric Ketcham, an emergency department physician and addiction medicine specialist at Presbyterian Española Hospital.
News of New Mexico’s increase in overdose deaths comes as the state is moving forward with long-awaited behavioral health reforms. Last week, a state commission approved a plan to upgrade behavioral health services in Santa Fe, Rio Arriba and Los Alamos counties, with an emphasis on expanding medication-assisted treatment for addiction and detoxification. The plan also includes initiatives to increase access to housing aid and transportation, and to boost the behavioral health workforce.
The state’s opioid crisis has received renewed attention following recent reports that U.S. Drug Enforcement Administration agents allowed hundreds of thousands of fentanyl pills to hit the streets as they sought to catch high-level dealers between 2023 and 2025. Attorney General Raúl Torrez has opened an investigation into the allegations, and Gov. Michelle Lujan Grisham has promised to pursue all possible legal action against the DEA and its agents.
“It is the most derelict, despicable act in my long career,” Lujan Grisham said at a news conference late last month at the Albuquerque headquarters of the New Mexico Office of the Medical Investigator, where many victims of fentanyl overdoses have been examined.
The governor cited a high overdose rate and drug trafficking in Española and surrounding Rio Arriba County among her reasons for declaring a public safety emergency in August, when she deployed New Mexico National Guard troops and sent the first in a series of funding surges — now totaling $9 million — to law enforcement agencies in the region.
A month earlier, she had announced a new policy of taking drug-exposed newborns into state custody, which has affected scores of infants and families.
Ketcham noted opioid use disorder is a medical condition, not “just a bad habit.”
“It is very serious and unfortunately frequently lethal or disabling medical condition,” he said.
At Presbyterian, he added, “Our goal is to save lives and improve the quality of life and give people their lives back.”
Ketcham calls it his dream to one day knock Rio Arriba County off the U.S. Centers for Disease Control and Prevention’s list of counties nationwide with the highest overdose death rates.
When they peruse that data someday, “Folks will say, ‘Rio Arriba County, never heard of that,’ ” he said.
‘The fentanyl problem’
Humans have been using opiates, naturally occurring substances made from poppy sap and fibers, for thousands of years. In the past 150 years or so, chemists have developed partially and fully synthetic opioids, like oxycodone, hydrocodone, methadone and fentanyl.
Opioids work at what are called mu receptors throughout the body, which interact with endorphins, or feel-good hormones that relieve pain and stress, Ketcham said. Because of the way they interact with those receptors, opioids often lead to dependency and bring on withdrawal symptoms after decreasing or stopping use. Withdrawal can manifest in symptoms ranging from nausea and vomiting to anxiety and depression to body aches and pain.
Ketcham noted what he called “tremendous overprescribing” of prescription opioid painkillers that began in the early 1990s and propelled the opioid crisis, resulting in public litigation against manufacturers and distributors nationwide and settlements worth billions of dollars aimed at alleviating the harm — including nearly $1 billion in New Mexico.
People who used prescription opioids started switching first to heroin and then to fentanyl six or seven years ago, he said.
A short-acting opioid, fentanyl is particularly addictive because it offers such speedy relief, Ketcham said. It works even faster than heroin and oxycodone.
“By 2022, I would say it was almost really hard to find heroin in the local illicit drug market,” he said. “It had pretty much all been replaced by fentanyl, and most of what was sold as heroin was usually contaminated with fentanyl.”
A woman helps her partner inject a hit of heroin while sitting in the shrubs along St. Francis Road in Santa Fe in June 2025. New Mexican file photo CDC data shows this progression in overdose deaths. In 2015, the data shows fewer than 15% of drug overdoses in New Mexico were attributed to synthetic opioid analgesics other than methadone, a category that includes fentanyl. In 2025, the rate was more than 85%.
Opioids — and specifically fentanyl — have also made their way to some of New Mexico’s most vulnerable residents. Twenty-eight children 14 and under died of overdoses from 2013 to 2024, according to data published by the New Mexico Department of Health. In that time, a dozen children died from fentanyl overdoses.
Death from opioid overdose is due to a lack of oxygen, as opioids affect the parts of the brain that regulate breathing. A high dose of fentanyl can cause breathing to slow and stop. If no one is around to administer the opioid overdose reversal drug naloxone, a person overdosing can stop breathing for good.
The distribution of naloxone in the state has increased in recent years, a practice that has prevented an untold number of deaths.
Links to crime
Along with driving opioid deaths, the increased use of fentanyl in New Mexico is driving crime, prosecutors say.
Sam Bregman, a one-time Democratic gubernatorial candidate and current district attorney in Bernalillo County, said in a news conference in late June his office sees roughly 40 to 60 criminal cases every day; in about half of them, the defendant is charged with possessing fentanyl.
“So much of crime is driven from fentanyl. So much of our efforts, when it comes to diverting people out of the criminal justice system, is trying to deal with this horrific drug called fentanyl,” Bregman said. “We continue to prosecute those who are willing to put this poison on the streets, but I cannot prosecute my way out of the fentanyl problem.”
The varied OD victims
The victims of fatal drug overdoses in New Mexico are often homeless, but many are not. They are parents, grandparents, sons and daughters, churchgoers, construction workers, college graduates, athletes, Pueblo people and, sometimes, law enforcement officers.
The most likely places for a drug overdose in Santa Fe are parking lots, single-family houses and apartment complexes, according to a 2024 report.
On an evening in September 2025, several family members of 34-year-old Skye Miller were waiting outside her home in the city when Santa Fe County sheriff’s deputies arrived. They had called 911 fearing she was dead inside her locked apartment, according to sheriff’s office reports.
Miller had overdosed three times within the previous month, and family members had not been able to contact her for a day, they told law enforcement. Deputies opened the door to Miller’s apartment and found her dead in her bedroom, holding items commonly used to smoke fentanyl.
Miller’s uncle Mark Pilato told The New Mexican earlier this year his niece was “beautiful and loved by many,” a mother who had been enrolled in nursing school.
During a funeral service held in the weeks after she died, the family’s church was packed with people mourning the loss, he said.
Over the course of 2025, many who overdosed in Santa Fe weren’t discovered until it was too late.
A woman dialed 911 on the afternoon of Jan. 4, 2025, after she found another woman face-down behind an apartment complex in the Hopewell-Mann neighborhood. The unresponsive woman had blue lips and was stiff to the touch, according to a police report.
Santa Fe police wrote the 35-year-old woman was found with a light blue lighter in one hand and a “tooter” — a straw used to smoke fentanyl, usually off a piece of aluminum foil — in the other. There was also an unopened bottle of vodka and a syringe on the ground nearby, police wrote.
About 24 hours later, another call came in reporting a death at a house near Christus St. Vincent Regional Medical Center. A 38-year-old woman had been lying dead on a couch for hours while her roommate believed she was asleep, officers wrote in a report. The roommate said the woman had used fentanyl the previous night, and police observed needle marks and old bruising on her arms.
Later the same month, a woman was found dead in a tent in a field off Alto Street, a report states. She was wearing a black sweater and blue jeans and holding a rolled-up dollar bill in her left hand; a small piece of aluminum foil sat next to her.
Police could not find identification for the woman. Officers took a picture of her face and ran it through facial recognition technology but were unable to identify her. Officers noted she appeared to be 30 to 40 years old and had a feather tattoo on her left forearm.
A man and woman who were living on the streets of Santa Fe earlier this year spoke about how a man “went down” — overdosed — in their camp in November. The group had naloxone on hand and revived him.
The couple said they hear about overdoses elsewhere in the city “all the time,” especially as homeless people increasingly camp alone to evade detection by police, who have been sweeping encampments and arresting campers.
“When you pitch a tent, you don’t want five other tents around,” the man said. “You want to be by yourself. If you do fentanyl when you’re by yourself, you’re going to die.”
‘A hard, hard choice’
Getting someone into treatment for opioid use disorder can be tricky. When they’re finally ready to go, there might not be an available bed in the area for detoxification and rehabilitation, advocates say.
A handful of treatment facilities in New Mexico have shuttered over the last few years — Life Health Center in Santa Fe and Mountain Healing Center, which ran three facilities throughout the state.
The regional behavioral health reforms — such as the plan approved last week for Santa Fe, Rio Arriba and Los Alamos counties — are aimed at increasing treatment options.
Even as access to treatment expands, however, getting started can feel nearly impossible.
Recovery can be “baffling,” said Ronnie Flores, a peer support supervisor for Presbyterian Healthcare Services’ hospitals in the state’s northern region. Abstinent from drugs and alcohol for nine years, Flores uses his experience to help others interested in pursuing recovery.
But he’s under no illusion that it’s an easy process.
“Recovery is lifelong,” Flores said. “I had to come to terms that I can never take a drink again in my life. I can never use a drug again in my life, right? And that’s a hard, hard choice.”
David Daniels, manger of the Department of Health’s Harm Reduction Section, noted harm reduction efforts can help people struggling with addiction make that choice when they’re ready — and use drugs safely in the meantime.
Daniels’ team can test street drugs, provide sterile drug use equipment and offer overdose-reversing naloxone, interventions that can prevent overdoses and reduce the transmission of diseases — like HIV and hepatitis — that can spread through shared needles.
“With harm reduction, the easiest way to explain it is meeting people where they’re at,” Daniels said.
Several confounding factors — such as access to transportation, housing or food — can also impact whether a person with substance use disorder can follow through with addiction treatment.
“When you throw that addiction on all of the other obstacles, it’s not that it’s insurmountable, but so much more tempting to just give up,” said Enrique Enguidanos, CEO of the Washington-based care navigation company Community Based Coordination Solutions.
That’s especially true for the parents of drug-exposed newborn babies who are placed on safe care plans through New Mexico law under the federal Comprehensive Addiction and Recovery Act. Enguidanos’ company has worked with the state’s CARA program, which has seen parents fail to follow through.
A 2023 report by the Legislative Finance Committee found only 190 of the 1,300 families with substance-exposed newborns in the program had accepted referrals to addiction treatment.
Ramping up treatment
For nearly two decades, New Mexico has been exploring medication-assisted treatment, an option research has shown to produce a high rate of abstinence from drug use while reducing healthcare costs in the long run. Investments were slow to come.
Democratic state Sen. Mimi Stewart of Albuquerque in 2009 sponsored legislation directing the state Health Department to convene a task force to identify the need for and barriers to such treatment for New Mexicans, spurred by a federal study that found some 55,000 of the state’s residents at the time could benefit from it.
State budget bills show direct appropriations for medication-assisted treatment started in fiscal year 2024, largely bankrolled by settlement funds from the state’s lawsuits against opioid producers and distributors. The Department of Health received $3.5 million for medication-assisted treatment in that year, while the Corrections Department got $1 million, according to a Legislative Finance Committee report.
Fiscal year 2027, which began July 1, marks the New Mexico Department of Health’s fourth year of receiving a $3.5 million appropriation from settlement funds, with much of the money going toward medication-assisted treatment, spokesperson David Morgan wrote in an email to The New Mexican.
Over the past few years, the Health Department has greatly expanded a medication-assisted treatment program — known as New Mexico Pathways — to all public health offices across the state, the state Health Department’s Daniels said.
“We are seeing individuals enroll into our program in large numbers every single month,” he said.
Presbyterian Española Hospital recently expanded its addiction medicine services, dedicating the former emergency department to a clinic that specializes in substance use disorder treatment and behavioral health care.
The clinic, located in what was prime hospital real estate, treats opioid use disorder with two main medications, Ketcham, the addiction doctor, said.
There’s methadone, a slow-onset opioid that has been around since the 1930s and takes about 24 hours to metabolize half a dose.
However, Ketcham noted people can overdose on methadone, particularly when mixing with other substances. That’s why it’s managed in a methadone clinic with a gradual increase in dosage.
And there’s buprenorphine, which is very effective at relieving pain, cravings and withdrawal symptoms while being far less sedating and less likely to cause an overdose than other opioids.
Ketcham said the drug — approved by the U.S. Food and Drug Administration for opioid use disorder treatment in 2002 — binds to patients’ mu receptors particularly well, a quality that can greatly reduce the likelihood of relapse but may also precipitate withdrawal from other opioids like fentanyl, which can be stored in body fat.
Ketcham estimated about 80% of the addiction medicine clinic’s patients are prescribed buprenorphine. The other 20% — typically people for whom buprenorphine is ineffective or otherwise not a good option — take methadone.
“When we get people in treatment, and they’re no longer having to use illicit drugs, and they’re able to just take medication that’s provided through a pharmacy, it’s safer, and they get their lives back,” Ketcham said. “They start getting jobs back and taking care of their families. Their families heal, and all that emotional stress really improves.”
Staff writer Esteban Candelaria contributed to this report.
This article first appeared on Searchlight New Mexico.